| Payment ID | 5582 |
|---|---|
| Date Created | 08/12/22 8:54 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 4005 |
| Authorization Number | |
| Applicant Information | |
| Name | Ashley Drake |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170500376 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,837.94 |
| Receipt Date | 08/04/2022 |
| Comments | hotel stay at Woodspring Suites starting 8/4/22 through 9/3/2022/, this amount includes a refundable deposit of $75.00 due at check out |
| Receipt | 5582-Drake.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | BP |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/12/2022 |
